In his Letter of the Day, Friday, August 28 - 'Whiplash and motor premiums' - Joseph Spencer blames "some small but active sections of the legal and medical professions, aimed at extracting the maximum amounts from the motor insurance industry" for "one of the main reasons for the size of motor insurance premiums".

It would be wise of the insurance companies to respond to Spencer's assertions. Their clients have a right to know what contributes to constant rate hikes. And, although medical practitioners are taught never to use their trusted status to falsely state injuries, human beings are fallible so I cannot categorically deny that a fraction of a per cent of doctors may do this.

What concerns me, however, is the general perception that whiplash neck injuries are not as common as they seem. They occur as a result of sudden backward movement followed by sudden forward movement of the neck. Such acceleration-deceleration injuries of the neck most often occur because of rear-end or side-impact crashes injuring muscles, liga-ments, tendons, joints, discs or bones of the neck. Oftentimes symptoms appear the day after the crash. Interestingly, whiplash often occurs because of rear-end collisions at speeds below 22.5 kilometres per hour (14 mph). Although more than 66 per cent recover fully in a few months, some will go on to suffer 'Late Whiplash Syndrome' (chronic symptoms lasting longer than six months) and two per cent will be permanently impaired (perhaps even permanently disabled - the two are not synonymous).

The grading of whiplash injury varies but most accept grade one as - mild - complaint of neck pain and stiffness, tenderness but no limitation of movement, ligamentous injury or neurological signs. Grade two - slight - same complaints as above but with specific site(s) of tenderness and limitation of movement (musculo-skeletal signs). Grade three - moderate - as above but with more stiffness, more tenderness, ligamentous injury/instability and possible neurological symptoms (pain that travels away from the neck and possibly upper limb pain, numbness and/or weakness). Grade four - severe - symptoms and examination findings as above but with fracture and/or dislocation.

Many whiplash victims will need medication, (perhaps) immobilisation and (often) physical therapy. Some will need to be seen by an orthopaedic specialist. Most recover in a timely manner but about one-third will have prolonged symptoms and require extended medical care. As stated before, a small percentage will suffer symptoms indefinitely.

Facial expression

Pain cannot be measured in the blood, by X-rays or scans; physicians must depend on the patient's history and description of the pain to guide them. And, for reasons not fully understood, people experience pain differently. We, therefore, observe the patient's facial expression, movement and examine for clues that pain is present. We ask patients to grade their pain on a visual-analogue scale from one to 10 (mildest to most severe). So, because whiplash injuries are so easy to occur and, therefore, very common, if a patient was in a collision and complains of neck pain and stiffness, we must assume his/her veracity and assess and treat accordingly.

However, there is a controversial 'whiplash culture' - possibly as a result of tissue injury aggravated in patients predisposed to bio-psychological factors. There also seems to exist a minority of patients suffering from 'compensationitis' (the persistence of symptoms in the expectation of monetary compensation). A 2008 article by Poorbaugh, Brismee, Phelps and Sizer (Late Whiplash Syndrome: A Clinical Science Approach to Evidence-Based Diagnosis and Management) stated it best when it warned against the presumption of malingering in whiplash claims as it could "create a grave injustice to patients".

Garth A. Rattray is a medical doctor with a family practice. Feedback may be sent to garthrattray@gmail.com or columns@gleanerjm.com.